How to file a complaint with the Audit & Enforcement Unit

How to file a complaint with the Audit & Enforcement Unit

The DWC Audit & Enforcement Unit does not resolve disputes about benefits, but it tracks complaints against workers' compensation claims administrators (insurance companies, selfinsured employers and third party administrators) and takes action to make sure the law is followed. . Any dispute over benefits must be brought before the Workers' Compensation Appeals Board (WCAB). While not all complaints result in investigations or audits, it is important for the Audit & Enforcement Unit to hear your complaint.

The audit referral form (DWC-AU-906) may be used to file a complaint against the claims administrator. When not using the audit referral form, please include the following information in a complaint:

1. Claims administrator company name, address and telephone number 2. Injured worker name, address and telephone number 3. Claim number and date of injury 4. Employer name 5. Workers' Compensation Appeals Board case number, if applicable 6. Attach copies of any supporting documentation.

Complaints (including copies of documents) that are 50 or fewer pages may be emailed to the DWC Audit & Enforcement Unit at dwcauditunit@dir. . A copy of any complaint can also be sent to the claims administrator. Sometimes this helps to resolve a problem.

If your complaint (including copies of documents) is 50 or more pages, it must be mailed to the DWC Audit & Enforcement Unit at the following address:

DWC Audit & Enforcement Unit Attention: Complaint Desk 160 Promenade Circle, Suite 340 Sacramento, CA 95834

Once the complaint has been logged, the complainant will receive an acknowledgment letter informing the complainant that the complaint was received by the audit unit.

Because of confidentiality restrictions imposed by Labor Code Section 129, you will not be informed of the results if your claim is audited. For more information, please see the Division of Workers' Compensation webpage at dir.dwc/ or call the Information and Assistance line at 1-800-736-7401.

Please be advised that if your complaint form is marked confidential there is a possibility that the audit unit will not be able to audit the complaint within the statutory guidelines for audit timeframes.

DIR PRIVACY NOTICE: The Department of Industrial Relations, Division of Workers' Compensation uses the information in your complaint (1) to monitor workers' compensation claims administrators; (2) to assist DWC and other government agencies in general civil and

DWC-AU-905 (Rev. 09/20)

criminal law enforcement; and (3) to conduct research on the workers' compensation system. If you indicate that you want your complaint kept confidential, the Audit & Enforcement Unit will not share your complaint with any party named in your complaint. If you do not request confidentiality, the Audit & Enforcement Unit may share your complaint with the claims administrator. Please note that your complaint and your workers' compensation claim information cannot be disclosed to the public under the Public Records Act. If you have questions about this notice please write to Privacy@dir. .

DWC-AU-905 (Rev. 09/20)

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